Case-Mix Study Of Surgery Patients With Ectopic Pregnancy Based On Path Analysis And Decision Tree Model

ObjectivePath analysis and decision tree model were used to conduct a case-mix study of 1470 surgery patients with ectopic pregnancy.It can find out the causes of the increase in the medical expenses of the research subjects and enable the relevant departments to control medical expenses by analyzing the composition of hospitalization expenses.At the same time,through scientific and reasonable grouping and the corresponding statistical indicators of each DRG group,it can provide methodological reference for the hospital performance evaluation and the implementation of DRGs payment.MethodsThe data from the sample hospital's HIS system that all the medical records of surgery patients with ectopic pregnancy from 2013 to 2016 were extracted through SQL statements.The study described a descriptive analysis of the demographic characteristics and hospitalization expenses of ectopic pregnancy patients.The Cochran Armitage trend test was used to analyze the trend of treatment and case classification of the study subjects;Analysis of variance,t test and rank correlation analysis were used to analyze the single-factor analysis of the hospitalization expenses of surgery patients with ectopic pregnancy and the correlation among various factors.Multiple linear regression and path analysis were used to analyze the multivariate analysis of the hospitalization expenses of surgery patients with ectopic pregnancy.The study used Chi-square automatic interaction test(CHAID)to case grouping and used Kruskal-Wallis test and coefficient of variation(CV)to judge the rationality of case grouping results.The test level ? is 0.05.The statistical software used in the study is SPSS16.0,SAS 9.1 and Amos Graphics.ResultsThe study found that the surgery patients with ectopic pregnancy were mainly 20 to 40 years old and 98.1% of the cases were tubal pregnancy.The proportion of laparoscopic surgeries increased from 72.4% in 2013 to 92.1% in 2016;The proportion of CD cases increased from 17.7% to 50.3%;The average length of hospital stay decreased from 6.27 days to 5.37 days;The average hospitalization expenses increased from 10770.67 RMB to 11972.36 RMB;The expenses of treatment,drug,and inspection accounts for more than 70%.Path analysis showed that the categorization nodes of DRGs in surgery patients with ectopic pregnancy were treatment,concomitant diseases,case classification,blood transfusion,salvage,and complications;The decision tree model established six DRG groups.The average expenses of each DRG group were 9077 RMB,10092 RMB,10654 RMB,10462 RMB,11741 RMB and 12336 RMB respectively.The adjusted weights were 0.8590,0.9657,0.9723,0.9366,1.0028 and 1.0601 respectively.The results of the performance evaluation of 7 doctors showed that: The number of surgery patients with ectopic pregnancy admitted was doctor A,followed by doctor B;The highest CMI value was doctor D,followed by doctor E;Doctor A's time efficiency index was the lowest,doctor G was the highest;Doctor B's cost efficiency index was the lowest,doctor F was the highest;ConclusionsPath analysis can study the influencing factors of hospitalization expenses from both direct and indirect effects and its results are closer to the actual clinical process.At the same time,medical institutions can use the layering mechanism of path analysis to control the medical expenses.DRGs can be applied in the fields of medical insurance payment and medical institution performance evaluation,but the grouping process still needs to be constantly optimized and improved,so that the grouping result is more scientific and reasonable.